Provider Demographics
NPI:1124353107
Name:FELICIA A. OTA, M.D., INC.
Entity type:Organization
Organization Name:FELICIA A. OTA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-708-1090
Mailing Address - Street 1:15503 VENTURA BOULEVARD
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-708-1090
Mailing Address - Fax:818-708-3238
Practice Address - Street 1:15503 VENTURA BOULEVARD
Practice Address - Street 2:SUITE 200B
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-708-1090
Practice Address - Fax:818-708-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65703207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty